Electronic Health Record Clinical Decision Support to Close the Human Papillomavirus Vaccination Gender Disparity in Children Aged 9 and 10 Years.

We performed a quality improvement project (31 clinics; July 2021 to October 2023) to increase human papillomavirus vaccination initiation frequency and decrease gender disparity in children aged 9 and 10 years. The 11 process changes included electronic health record clinical decision support (CDS) tools for providers, staff, and parents and medical assistant participation. In phase 1 (preparation), initiation frequency was lower in boys (250 of 1688 visits, 15%) than girls (289 of 1549 visits, 19%; = .

Women's perceptions of body mass graphics and their preferences for weight counselling.

Health care providers may lack data-driven guidance about best practises for discussing weight. We assessed women's self-perception of body mass index (BMI) and preferences for weight counselling by provider characteristics and the initiating question. A voluntary, anonymous survey was completed by 756 women (age ≥ 19 year) at our tertiary care obstetrics and gynaecology clinics in autumn 2021.

Burnout, Resilience, and Mindfulness in Healthcare Workers in a Medically Underserved Region during the COVID-19 Pandemic.

Objectives: To evaluate employee burnout, work conditions, resilience, and mindfulness at an academic medical center in a US medically underserved region during the coronavirus disease 2019 pandemic.

Methods: We surveyed employees from August 7, 2020 to January 17, 2021. Respondents completed the Maslach Burnout Inventory (MBI), the Areas of Worklife Survey, the Connor-Davidson Resilience Scale, and the Philadelphia Mindfulness Scale (PHLMS) and answered a question about intention to stay in the present job until retirement.

Charcot arthropathy outcomes after early referral to a regional tertiary care foot clinic.

Background: Community physicians may not encounter Charcot arthropathy frequently, and its symptoms and signs may be nonspecific. Patients often have a delay of several months before receiving a formal diagnosis and referral for specialty care. However, limited Canadian data are available.

Electronic Health Record-Integrated Clinical Decision Support for Clinicians Serving Populations Facing Health Care Disparities: Literature Review.

Objectives: To review current studies about designing and implementing clinician-facing clinical decision support (CDS) integrated or interoperable with an electronic health record (EHR) to improve health care for populations facing disparities.

Methods: We searched PubMed to identify studies published between January 1, 2011 and October 22, 2021 about clinician-facing CDS integrated or interoperable with an EHR. We screened abstracts and titles and extracted study data from articles using a protocol developed by team consensus.

Modes of failure of hip hemiarthroplasty for femoral neck fracture.

Background: Hemiarthroplasty is a common treatment for displaced femoral neck fractures, but limited Canadian data are available about hemiarthroplasty failure. We evaluated the frequency and predictors of hemiarthroplasty failure in Manitoba.

Methods: In this retrospective multicentre province-wide study, billing and joint registry databases showed 4693 patients who had hemiarthroplasty for treatment of femoral neck fracture in Manitoba over an 11-year period (2005-2015), including 155 hips with subsequent reoperations (open or closed) for treatment of hemiarthroplasty failure.

Collection and Reporting of Patient-reported Outcome Measures in Arthroplasty Registries: Multinational Survey and Recommendations.

Background: Patient-reported outcome measures (PROMs) are validated questionnaires that are completed by patients. Arthroplasty registries vary in PROM collection and use. Current information about registry collection and use of PROMs is important to help improve methods of PROM data analysis, reporting, comparison, and use toward improving clinical practice.

Rectal Perforation by an Intrauterine Device Leading to Fatal Intra-Abdominal Sepsis and Necrotizing Fasciitis.

Background: Colorectal injury from an intrauterine device (IUD) is rare but may lead to major complications.

Case: A 55-year-old woman presented to a tertiary care hospital with 4 days of generalized weakness, confusion, dysuria, and lower back pain. She provided a vague history of an unsuccessful attempt to remove an IUD 30 years prior.

Home Gun Safety Queries in Well-Child Visits.

This study evaluates the association of adding questions about gun storage in patient households in the electronic health record with documentation of gun storage in the context of mass shootings.

Quantifying Sex Bias in Clinical Studies at Scale With Automated Data Extraction.

Importance: Analyses of female representation in clinical studies have been limited in scope and scale.

Objective: To perform a large-scale analysis of global enrollment sex bias in clinical studies.

Design, Setting, And Participants: In this cross-sectional study, clinical studies from published articles from PubMed from 1966 to 2018 and records from Aggregate Analysis of ClinicalTrials.

Surgical site infection surveillance for elective primary total hip and knee arthroplasty in Winnipeg, Manitoba, Canada.

Background: Surgical site infections (SSIs) increase morbidity and mortality after primary hip and knee arthroplasty. We evaluated a surveillance program that tracked risk factors associated with infection after primary hip and knee arthroplasty in the Winnipeg Regional Health Authority.

Methods: Surveillance data from April 2010 to March 2015 were reviewed for all 12,636 primary hip or knee arthroplasties, including 1-year follow-up.

Bone Marrow Edema Syndrome in the Foot and Ankle.

Unlabelled: Bone marrow edema syndrome (BMES) is an uncommon and self-limited syndrome characterized by extremity pain of unknown etiology. Symptoms may include sudden or gradual onset of swelling and pain at rest or during activity, usually at night. This syndrome mostly affects middle-aged men and younger women who have pain in the lower extremities.

Mental health issues associated with foot complications of diabetes mellitus.

Background: The purpose of this study was to evaluate the effect of foot problems on mental health in diabetic patients and their caregivers.

Methods: Diabetic patients (47 patients with and 49 patients without foot problems), and 21 caregivers of patients with foot problems, completed outcome surveys. Foot problems included ulcers (41 patients [87%]), osteomyelitis (9 patients [19%]), and Charcot foot (8 patients [17%]).

Pseudo-outbreak of Phaeoacremonium parasiticum from a hospital ice dispenser.

In 31 patients, Phaeoacremonium parasiticum was recovered from bronchoscopy specimens (biopsies and aspirates). The pseudo-outbreak was caused by contaminated ice used to control hemorrhage during bronchoscopy and was associated with deficiencies in equipment cleaning. The bronchoscopy technique was modified, the ice dispenser was disinfected, bronchoscope reprocessing was improved, and there were no recurrences.

Effect of a preventive foot care program on lower extremity complications in diabetic patients with end-stage renal disease.

Background: Lower extremity complications are a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD) and diabetes mellitus. Patient education programs may decrease the risk of diabetic foot complications.

Methods: A preventive program was instituted, consisting of regular assessments by a foot care nurse with expertise in foot care and wound management and patient education about foot care practices and footwear selection.

Touch pressure and sensory density after tarsal tunnel release in diabetic neuropathy.

Background: Limited quantitative information is available about the improvement of protective sensation after tarsal tunnel release in patients with diabetic peripheral neuropathy.

Methods: Prospective, non-blinded, non-randomized case series of 10 feet in 8 diabetic patients and 24 feet in 22 non-diabetic patients who had tarsal tunnel release. Preoperative and postoperative (average, 8-9 months) anatomic, quantitative sensory testing was done with touch pressure 1-point threshold (Semmes-Weinstein monofilaments) and 2-point discrimination.

Blastomycosis presenting as multiple splenic abscesses: Case report and review of the literature.

A 31-year-old Canadian Aboriginal man from northwestern Ontario presented with left upper quadrant pain and a tender left upper quadrant mass. Evaluation with a computed tomography scan showed multiple lesions within the spleen, a collection between the splenic tip and splenic flexure of the colon, and several small adrenal lesions. Computed tomographic-guided needle biopsy showed necrotizing granulomatous inflammation and multinucleated giant cells.

Special report: highlights of the twenty-fifth annual summer meeting of the American Orthopaedic Foot and Ankle Society, Vancouver, Canada, July 16-18, 2009.

The Twenty-fifth Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society (AOFAS) was held 16-18 July 2009 at the Westin Bayshore Hotel in Vancouver, British Columbia, Canada. There were 521 registered attendees, including 339 (65%) individuals from 42 of the United States and 182 (35%) attendees from 32 countries outside the United States.

Blastomycosis in children and adolescents: a 30-year experience from Manitoba.

Blastomyces dermatitidis, a thermally dimorphic fungus endemic to areas of North America, causes a granulomatous infection which may affect any organ system. Since limited clinical data exist about pediatric blastomycosis, we conducted a retrospective review of medical records of pediatric patients with a laboratory-confirmed diagnosis of blastomycosis treated during a 30-year period at a tertiary care center. Thirty-four pediatric patients with blastomycosis were identified (20 [59%] male), with a mean age at diagnosis of 10 ± 5 years.

Upper extremity complications in patients with chronic renal failure receiving haemodialysis.

Limited data are available about disability associated with upper extremity complications in patients who receive haemodialysis for end-stage renal disease. In this study of 123 patients receiving haemodialysis, the mean Disabilities of the Arm, Shoulder and Hand (DASH) score was 31 ± 22 points, indicating markedly greater disability than in a normal population. Dupuytren's contracture was the most frequent deformity.

A case of diabetic Charcot arthropathy of the foot and ankle.

Background: A 61-year-old man with type 2 diabetes mellitus presented to a diabetic foot clinic 1 year after he injured his left foot in a slip injury. Examination showed collapse of the longitudinal arch with a rocker bottom deformity and a plantar ulcer under the plantar midfoot bony prominence.

Investigations: Radiographs of the foot.

First ray disorders in athletes.

Athletes who participate in contact sports (American football, soccer, rugby) or who are involved in high-impact sports (dancing, running, gymnastics) are susceptible to first ray forefoot injuries. Common first ray disorders in athletes include hallux rigidus, turf toe, sand toe, sesamoid disorders, and fractures. First ray disorders in athletes frequently are treated by nonoperative methods including relative rest, ice, elevation, activity modification, shoe modification, and insoles.

Special report: highlights of the Twenty-Fourth Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society, Denver, Colorado, June 26-28, 2008.

The Twenty-Fourth Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society (AOFAS) was held 26-28 June 2008 at the Denver Marriott City Center in Denver, Colorado. There were 442 registrants in attendance, including 81 individuals from 21 countries outside the United States. There were 176 abstracts submitted, and 46 (26%) abstracts were accepted for podium presentation.